ObjectiveThis review has summarized in detail the advances in computed tomography (CT) and magnetic resonance imaging (MRI) imaging in evaluating the efficacy of targeted therapy for gastrointestinal stromal tumor (GIST).MethodsTo summarize the image-related guidelines, consensus, international conference reports, and relevant knowledge of clinical research on the evaluation of the efficacy of GIST targeted therapy in recent years.ResultsThe CT and MRI manifestation after targeted treatment of GIST was closely related to pathological changes, including necrosis, cystic degeneration, and bleeding. CT was the preferred imaging method. Functional magnetic resonance imaging, such as diffusion weighted imaging (DWI), had made some progress. The main criteria for evaluating the efficacy of GIST targeted therapy were RECIST 1.1 and Choi criteria.ConclusionCT and MRI play an important role in evaluating the efficacy of targeted therapy for GIST.
【Abstract】ObjectiveTo study the diagnosis and the treatment of gastrointestinal stromal tumor (GIST). Methods In this retrospective study, tissue slices, including immunohistochemical examinations, of 48 patients with GIST from January 1999 to December 2004 were collected. All of their clinical symptoms, pathologic characters, and surgical treatment and other information were also analyzed. ResultsTwenty-seven males and 21 females with a mean age of 68 were included in this report. All patients received tumor resections. Tumors were located in the stomach in the 29 cases (60.4%), and 11 cases (22.9%) were in the small intestine. The main clinical manifestations were alimentary tract hemorrhage (52.1%) and abdominal mass (35.4%). Immunohistochemical examination showed the positive rate of CD117 was 83.3%(40/48), and CD34 was 77.1%(37/48). Conclusion GIST mostly occurs at stomach and small intestine in aged people with clinical manifestations of alimentary tract hemorrhage and abdominal mass. The diameter of the mass is an important clinical index to distinguish malignant and benign tumors. The diagnosis of GIST depends on the combination of pathological and immunohistochemistry examinations. Complete regional resection of the tumor may be the most effective treatment.
ObjectiveTo discuss the role of imatinib preoperative chemotherapy in treatment of advanced gastrointestinal stromal tumor(GIST). MethodThe related literatures about imatinib preoperative chemotherapy for GIST were reviewed. ResultsImatinib preoperative chemotherapy is an effective treatment for advanced GIST, which significantly improve the resection rate and prolong the overall survival time for patients with advanced GIST. ConclusionsPreoperative imatinib treatment has good effect for metastatic or locally advanced GIST. It should be individualized by gene type of the GIST, which is deserved to be further studied.
ObjectiveTo investigate the current status and hotspots in researches of gastrointestinal stromal tumor.MethodsThe literatures related to gastrointestinal stromal tumor and published from 2000 to 2019 were extracted from Web of Science Core Collection. Visualization analysis was conducted by utilizing CiteSpace and VOSviewer software based on bibliometrics methods.ResultsA total of 3 226 articles and reviews were retrieved. The number of publications increased from 2000 to 2019, from the initial 34 publications gradually increased to 241 in 2019, and the maximum number of publications was 265 in 2015. The most productive five countries in terms of publication number were: 907 in the United States, 540 in China, 522 in Japan, 219 in Germany, and 214 in Italy. Co-occurrence networks of keywords were divided into three clusters: targeted therapy, clinical management, and pathogenesis research. Co-citation analysis of literatures contained 9 clusters, and cluster #0 prognosis was the latest cluster, indicating the research frontier and tendency.ConclusionsThe United States and its domestic institutes are the pioneers. Targeted therapy, clinical management, and pathogenesis researches are the main research filed. Prognosis research may be the new research tendency, and clinical and basic researches are still hotspots in medical research.
【摘要】 目的 分析胃肠道间质瘤（gastrointestinal stromal tumors，GIST）的螺旋CT（multi-detector row spiral computeel Tomography，MSCT）表现，评价其对该病的诊断价值。 方法 回顾性分析2000年3月—2010年10月经手术病理证实的32例GIST的MSCT表现，并将其与病理的生物学危险性进行对比研究。 结果 病理高、中、低及极低危险性GIST依次为15、6、7、4例。GIST主要CT表现，肿块腔外生长为主，大部分病灶边界清楚，呈类圆形或分叶状，密度均匀或不均匀，3例可见钙化，GIST增强静脉期强化较动脉期更明显，局部均无淋巴结转移，转移到肝脏的4例，同时伴前腹壁转移1例。15例肿块长径≥5 cm，密度多不均匀，可有囊变、坏死、出血等，增强不均匀强化，其中11例病理为高风险性；17例肿块长径lt;5 cm的病灶中，大多中度均匀强化，其中13例为中度及以下危险性。 结论 GIST患者的MSCT表现具有一定的特征性，MSCT对准确定位、术前估计肿瘤的风险级别、术后随访有重要价值。【Abstract】 Objective To investigate the imaging features of multi-slice spiral CT (MSCT) for gastrointestinal stromal tumors (GIST) and its diagnostic value. Methods We retrospectively analyzed the MSCT manifestations of 32 cases of GIST confirmed by operation and pathology between March 2000 and October 2010. Comparative study was then carried out between MSCT manifestations and patho-physiological risks. Results Of the 32 GIST lesions, 15 presented with high biological risks, six moderate risks, seven low risks and four very low risks. The MSCT results manifested the following main features. Exophytic growth was predominating; Most lesions were with well-defined margins, and were rotund or lobular in shape with homogeneous or heterogeneous density. Three lesions manifested calcification. The enhancement degree of GIST in portal vein phase was more obvious than in arterial phase. There was no metastasis to local lymph nodes. Hepatic metastasis occurred in four cases, one of which was accompanied with anterior abdominal wall metastasis. Of the 15 lesions with maximal diameter longer than 5 cm, MSCT showed obvious cystic changes, necrosis or hemorrhage within the mass most of which was in heterogeneous density, and heterogeneous enhancement; Eleven out of the 15 lesions were at high risk. Among the 17 lesions with maximal diameter shorter than 5 cm, MSCT showed homogeneous enhancement, and 13 of them were at moderate risk or below. Conclusion The MSCT imaging of GIST manifests some certain characteristics. It is valuable in locating the lesion precisely, estimating the risk level of the tumor, and postoperative follow-up for patients with GIST.
ObjectiveTo summarize the pathogenesis and epidemiology features of gastrointestinal stromal tumor(GIST), explore its diagnosis and therapy, and analyze its prognosis. MethodThe pertinent literatures about the pathogenesis, epidemiology features, diagnosis, therapy, and prognosis of GIST in recent years were reviewed. ResultsGIST was non-epithelial tumor which derived from interstitial cells of Cajal, was the most common mesenchymal tumor about accounting for 1%-3% in the digestive tract tumor. The median onset age of patients with GIST was 40-60 years. The gastric stromal tumor was about 60% in all the digestive tract tumor. The current consensus statement was that there was a relation between the pathogenesis of the GIST and proto-oncogene c-kit or platelet-derived growth factor receptor alpha(PDGFRα)gene mutation. But the mutations of PDGFRαand c-kit gene did not emerge at the same time in the same patient. The clinical manifestations of GIST were not specific, and the diagnosis mainly depended on endoscope and image technology, the correct diagnosis depended on pathological examination. The treatment of GIST was given priority of surgery and molecular targeted drug therapy, and the prognosis was closely related to risk assessment stratify of GIST. ConclusionsGISTs are mesenchymal tumors that has a potential of malignant transformation, the risk classification criteria for aggressive clinical course of primary GIST is an important indication for guiding the clinical therapy and prognostic evaluation. Further research would be needed in prevention, diagnosis, treatment, and relapse prevention of GIST.
【摘要】 目的 探讨胃肠道间质瘤(GIST)彩色多普勒超声表现及其在诊断中的应用价值。 方法 回顾性分析2008年1月-2010年7月75例经病理证实的GIST的彩色多普勒超声声像图表现，将其与手术病理结果进行对比分析。 结果 GIST患者中男性高危险度肿瘤的比例较女性高（χ2=7.210，Plt;0.01）。肿瘤的大小、内部回声与其病理危险度高低有关:危险度低者、肿瘤最大径lt;5 cm，内部回声较均匀；危险度高者，肿瘤最大径≥5 cm，内部回声不均匀。肿瘤的彩色血流分布与其危险度高低无明显相关。常规的超声检查对肿瘤检出率较高，在胃及直肠的GIST诊断准确率高于其他部位的GIST。 结论 彩色多普勒超声检查有助于GIST的定位及分化程度的判断，可作为首选检查方法。【Abstract】 Objective To investigate the value of ultrasonography in the diagnosis of gastrointestinal stromal tumors (GIST). Methods The color sonographic performances obtained in 75 patients with pathologically proved GIST from January 2008 to July 2010 were retrospectively analyzed. The sonographic findings were compared with pathological results. Results The proportion of high-risk cancer in male patients with GIST was higher than that in women (χ2=7.210, Plt;0.01). The tumor size and internal echo level were related to its pathologic risk: in low-risk GIST, maximum tumor diameter was lt;5 cm, and internal echo was more homogeneous; in high-risk GIST, maximum tumor diameter was ≥ 5 cm and internal echo was heterogeneous. There was no statistical difference between tumor blood flow distribution and GIST risk. Routine sonography examination had a higher rate of cancer detection and had a higher accuracy in the diagnosis of GIST in the stomach and rectum than those in the other parts. Conclusion Sonography helps to locate and diagnose malignant GIST, which is a common and preferred screening method.
Objective To investigate the correlation between the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII) and clinicopathological characteristics and prognosis in patients with gastrointestinal stromal tumor (GIST). Methods The clinicopathological data and blood routine results of 101 patients with GIST who were treated surgically in the General Hospital Western Theater Command PLA from December 2014 to December 2018 were collected retrospectively, samples were obtained to calculate NLR, PLR and SII. The optimal cutoff value of NLR, PLR and SII were evaluated by receiver operating characteristic (ROC) curve. The Chi-square test and t-test were used to analyze the relationship between NLR, PLR, SII and clinicopathological characteristics of GIST. The Kaplan-Meier plots and the log-rank test were used to analyze the influence factors affecting the recurrence-free survival (RFS) of patients with GIST. Multivariate Cox regression analyses was used to identify the independent influence factors affecting the RFS of patients with GIST. Results The preoperative peripheral blood NLR, PLR and SII of patients with GIST were correlated with the tumor site, tumor diameter and modified NIH risk stratification (P<0.05), but not with the mitotic count of tumor cells (P>0.05). Kaplan-Meier plots and log-rank test showed that NLR, PLR, SII, surgical method, tumor site, tumor diameter, mitosis rate and modified NIH risk stratification were the influential factors of RFS in with GIST. The multivariate Cox regression analysis revealed that postoperative whether to accept regular imatinib adjuvant therapy (HR=32.876, P<0.001), modified NIH risk stratification (HR=129.182, P<0.001), and PLR (HR=5.719, P=0.028) were independent influence factors affecting the RFS of patients with GIST. Conclusions Preoperative peripheral blood PLR, NLR, and SII are correlated with clinicopathological characteristics such as the tumor location, tumor diameter and modified NIH risk stratification, and are the influencing factors of postoperative RFS in patients with GIST. PLR is an independent predictor of RFS in patients with GIST.
Objective To summarize progress on diagnosis and treatment of advanced gastrointestinal stromal tumor (GIST). Method Through the retrieval of relevant literatures, the advances in the diagnosis and treatment of advanced GIST in recent years were reviewed. Results The diagnosis of advanced GIST mainly depends on imaging examination such as CT, MRI and endoscopy or endoscopic ultrasound. The diagnosis can be confirmed by needle biopsy for advanced GIST patients considering preoperative imatinib treatment. At present, the imatinib is the first-line therapy for patients with advanced GIST, followed by sunitinib and other novel targeted drugs. A multidisciplinary treatment strategy that included targeted therapeutic agents, combining with surgical resection, radiofrequency ablation and embolism chemotherapy have brought dramatic clinical benefit for advanced GIST. Conclusions GIST is easy to metastasis, clinicians should ensure early diagnosis and early treatment. In course of imatinib treatment, an individualized therapeutic regimen should be applied to treat advanced GIST based on specific situation of patients.